Drawings

Children's drawings drawings may be interpreted in a variety of ways. Tests
such as the Bender-Gestalt and the House-Tree-Person provide information
about perceptual-motor abilities and developmental level and can be useful
for this purpose. But children's drawings are also used to assess possible
sexual abuse (Conte et al., 1991; Kendall-Tackett, 1992). This latter use
lacks empirical support.

The assumption underlying this use is that, since emotionally disturbed
children are believed to reflect their problems in their drawings (e.g.,
Di Leo, 1973; 1996; Handler, 1996; Koppitz, 1968; Myers, 1978; Yates, Beutler,
& Crago, 1985), the drawings of children who have been abused will differ
from those of nonabused children. Free drawings, as well as the as the House-Tree-Person,
Draw-A-Person, and Kinetic Family Drawings are used and qualitative features
of the drawings, such as the colors used, the size and detail of body parts,
and the shape of the figures may be interpreted in terms of the presence
or absence of sexual abuse.

Burgess, McCausland and Wolbert (1981) claim that drawings in which a child
exhibits a shift from age-appropriate figures to more disorganized objects
or drawings with repeated stylized, sexualized figures indicate suspected
sexual abuse. Sahd (1980) recommends using drawings as part of the evaluative
interview of the sexual abuse victims and gives several examples of drawings
that reflect abuse histories. Kelley (1984, 1985) believes that human figure
drawings can be analyzed for "emotional indicators" (signs) in
young children who are unable to verbalize their trauma.

Cantlay (1996) claims that distress and trauma, including sexual abuse,
is reflected in drawings that include such signs as large heads, large,
empty eyes, abundant hair, shaded clouds, knotholes in trees, large hands,
large heads, large pointed teeth, abnormally tiny eyes, eyes without pupils,
crossed eyes, excessive details, box-shaped bodies, poorly integrated body
parts, lack of gender differentiation, hair that is long at the sides or
thinning at the crown, wedge-shaped windows, extraneous circles, and large
smoke trails coming out of the chimney. She cautions, however, that trauma
can only be determined from a series of drawings which contain a number
of these signs and that a single characteristic is not enough to indicate
abuse.

The presence of genitalia is often considered a sign of sexual abuse because
it is considered rare for normal, nonabused children to include genitals
in their drawings (Di Leo, 1973, 1996). Cantlay (1996), Hibbard, Roghmann,
and Hoekelman (1987), and Kelley (1984, 1985) claim that the presence of
genitalia in drawings means possible sexual abuse, Yates et al. (1985) believe
that incest victims either exaggerate or minimize sexual features in their
drawings and Miller, Veltkamp, and Janson (1987) state that sexualized drawings
indicate sexual knowledge beyond a child's years.

Empirical support for all these claims is extremely weak. In addition, a
major difficulty with these assumptions is that sexually abused children
are likely to have been interviewed about sexual abuse, have perhaps undergone
a distressing genital examination, and/or have been placed into sexual abuse
therapy. They are likely to have been shown undressed anatomical dolls where
their attention is focused on the genitals. They may have been asked repeatedly
to describe the details of the abuse. Therefore, genitalia may well become
salient and it is not surprising that some of these children will include
genitals in their drawings. In addition, other factors, such as family nudity,
the birth of a sibling, or viewing an X-rated video may affect the tendency
of a child to include sexual details in a drawing.

We have seen many examples of drawings by children that are erroneously
interpreted as bolstering a conclusion of sexual abuse: For instance:

· A 4-year-old girl drew nothing but circles which she
called "caves." One of the drawings looked to the psychologist
like male genitalia-when asked what it was, the child said it was "a
ball rolling into a lion's cave." The psychologist said this meant
the child has been subjected to some type of traumatic experience. But when
we saw evaluated the child, now age 5, we found that she was of borderline
intelligence and could not do any kind of drawing task. All she could do
was make scribbled circles.

· The child, when asked to draw a tree, also drew a cactus (Figure
2). This was interpreted in terms of "unconscious expression of danger
and fearfulness." However, the child was not asked if she had a cactus
in her yard (this was in Texas).

· The 7-year-old girl drew a picture of herself and her sister with
their hands up in the air with the father standing next to them and smiling
(Figure 3). She told the psychologist that she and her sister were "cheering
at a show." But the psychologist claimed that this really signified
a "helpless posture." She saw it as significant that there were
no fingers drawn on the hands and that the hands were large on the father 
she
claimed that abused children put large hands on the drawings of their perpetrators.
She also said that the thick lines in the crotch in the picture of the father
meant an emphasis on genitals, was probably a penis, and showed anxiety
about the father. She concluded that the girl, who continued to deny allegations
of sexual abuse by the father, had, in fact, been sexually abused by the
him.

· Hundreds of drawings over two years were interpreted by a psychologist
who saw two girls in a day care case with allegations of ritualistic satanic
abuse complete with costumes, masks, dead animals, sacrificed babies, blood,
feces, skeletons, and monsters. These allegations only surfaced during therapy.
The psychologist depended heavily upon the children's drawings in forming
conclusions about satanic ritual abuse. But all of the drawings were typical
of the types of scribbles and rudimentary figures drawn by 3- and 4-year-olds.
In her deposition the psychologist said that what she believed was significant
included practically every characteristic she believed she saw in the drawings:

Shapes that are untypical for 3- and 4-year-old children
Shapes that are phallic symbols.
Jiggly lines that indicate anxiety
Straight mouths that mean people can't say anything.
Jagged mouths that mean anxiety.
A mouth that is open and oval shaped
Darkened eyes
Eyeballs that are scribbled around
Eyes that are two different colors
Drawing something and then covering it up
Drawings something and not talking about it
Colors are very important and significant:
Black means the child is frightened or distressed; black is a morbid down
color
Red means angry, unless the child is drawing a pretty red flower, when it
is healthy
If everything is the picture is red or red and black, this is very suspicious.
Blue, brown, and orange mean fear, anger, and depression
Pink, red, and green are healthy colors

There are no empirical data to support these types of interpretations.
Despite their frequent use in child abuse investigations, drawings are subject
to the same criticisms as the anatomical dolls (Underwager & Wakefield,
1990; Wakefield & Underwager, 1988, 1989, 1994). Interpretations of
drawings lack validity and reliability as projective assessment devices.
In a review of the Draw-A-Person test in the Seventh Mental Measurements
Yearbook, Harris (1972) states that there is little evidence for the
use of "signs" as valid indicators of personality characteristics.
In fact, there is so much variability from drawing to drawing that particular
features of any one drawing are too unreliable to say anything about them.
Reviews by Cundick (1989) and Weinberg (1989) in the Tenth Mental Measurements
Yearbook note that there are no normative data establishing reliability
and validity of the Kinetic Drawing System. Smith and Dumont (1995) state
that four decades of research have failed to support the validity of human
figure drawings in assessing personality, behavior, or intelligence. They
observe that the confirmatory biases expressed in anchoring errors predispose
clinicians to find support for their initial opinions in whatever material
the client provides.

There are serious methodological problems with the few studies that claim
to find differences between sexually abused and nonabused children. As with
the anatomical dolls, studies with drawings with children suspected of being
abused would have to take place before children underwent physical examinations,
interviews, or therapy since these could affect their drawings. The persons
who rated the drawings would have to be blind concerning the child's status
regarding abuse. Ideally, a study would involve children who were all suspected
of being abused who, based on subsequent evidence, could be divided into
those who have and have not been abused. None of the studies meet these
criteria.

Another common drawing technique is an outline of the back and the front
of a naked male or a female. These cards are ostensibly used to enable the
interviewer to learn what terms the child uses for body parts. However,
this suggests that the purpose of the interview is to talk about sexual
matters. The interviewer also may also tell the child to put an X where
he or she was touched, which gives the message, "You were touched,
now show me where." A recent New Zealand research report questions
whether this constitutes a prompt or priming technique and states that drawings
increased errors and confabulation in children's accounts (Rawls, 1996).

Nevertheless, drawings may be useful evaluation aids. They can provide information
about possible perceptual-motor difficulties and developmental delays. They
can help build rapport and encourage narrative accounts. Goodwin (1982)
had children complete the Draw-A-Person task and the Kinetic Family Drawing
and also asked them to draw whatever they wanted, to draw the whole family
doing something together, and then to draw a picture of the alleged perpetrator.
She reports that drawings were helpful in understanding the child's fears
and anxieties, her view of the family, and her self-image, and in opening
up a workable line of communication between the evaluator and the child.
She cautions, however, that by themselves drawings are not sufficient to
form diagnostic conclusions. Miller et al. (1987) report that, once a child
has drawn a picture, he or she becomes highly verbal regarding the contents
of the drawing. They believe that drawings are less threatening to a child
who is hesitant to talk.

But drawings must not be used suggestively or the child's description of
the drawing selectively reinforced. It inappropriate to tell a child who
has not mentioned anything about abuse to "draw me a picture of what
daddy did to you." Any useful information about possible abuse will
come from the child's explanations of the drawing and spontaneous narratives
that this elicits. Details and signs in the drawings itself cannot be projectively
interpreted. Drawings may be valuable in building rapport and in facilitating
communication but they cannot be used in the absence of a description from
the child to draw conclusions about abuse.